Talk:Liver dialysis

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Liver dialysis is a fairly good title for this page, if its meant for lay person to access on as did Felix say. Since Iam associated in the marketing of this, let me say even the medical fraternity and the lay public understand this procedure as liver dialysis . Hbisr 05:33, 16 February 2006 (UTC)

[edit] Title

Is 'Liver Dialysis' a good title for this page? Things may a bit different in the US, but I've never heard of the extracorporeal albumin therapies being called that in the UK. Haemodialysis removes uraemic toxins down a concentration gradient over a semipermeable membrane, which is a principle properly known as dialysis. It doesn't require 'clean' albumin to act as a cleaning agent in the outside circuit. The other minor point is that haemodialysis works, unlike MARS; which at best acts as a bridging therapy for severely encephalopathic patients, for a day or two at the most. I don't want to sound pedantic, but I suppose we should be thinking about lay people reading this, perhaps with a personal interest, so I think the language ought to be neutral and a little more objective. Any thoughts?Felix-felix 17:00, 30 January 2006 (UTC)

It is a neologism to classify hepatic support measures. If you can suggest a better title that unifies all such measures. Dialysis is used here in the context of "organ function support", and is indeed quite imprecise. JFW | T@lk 22:13, 30 January 2006 (UTC)

I think liver dialysis is a fair description. Stedman's defines dialysis as separation across a semipermeable membrane on the basis of size and/or concentration.

Google yields 11,700 hits for "liver dialysis". Pubmed yields 24 articles for liver dialysis. As for it just being MARS... what about SPAD? Maybe Hswapnil can provide more insight into this/has an opinion on this; he is a nephrologist in the USA. Nephron 20:57, 2 February 2006 (UTC)

The same argument applies to SPAD, the second circuit makes no difference-and the point still stands-the similarities to dialysis are obvious-but dialysis doesn't need a cleaning agent in the form of albumin solution. And of course, it doesn't really work, unlike dialysis, which was my real point. I'm kind of with JFDW, perhaps an extracorporeal therapy umberella page leading to plasmapharesis, haemofiltration, MARS as well as dialysis?Felix-felix 22:29, 2 February 2006 (UTC)

>the second circuit makes no difference

Why you say that?

My understanding of MARS is that the second circuit is similar to a hemodialysis circuit and acts as a sink for the circuit in contact (through a semipermeable membrane) with the patient's blood. In other words, it maintains the concentration gradient between the blood and the first circuit. I don't think albumin is a cleaning agent so much as transporter for wastes that are protein bound. Regardless, I don't think the difference between liver dialysis (if I can use the term) and renal dialysis makes it necessary to apply a different term. You could as well argue that facilitated diffusion ought not be called diffusion 'cause it requires a transporter. As for MARS not working-- I agree that the results, thus far, are not impressive, but it is just in its infancy. Nephron 14:49, 3 February 2006 (UTC)

I was making a point about a second circuit making no difference to the semantic point about the title 'Liver dialysis'-rather than no difference to how well it works (which is pretty poorly on both counts). Your example using 'facilitated diffusion' is a good one, as the term is qualified. I would be in favour , for example, of 'albumin dialysis' as a qualified title for this page. It describes what the therapy involves, and, to my mind doesn't give the impression that there is an equivalent life-support therapy for liver failure to hemo or peritoneal dialysis for renal failure. It should have a clear statement in the article about it's efficacy. I think that we should bear in mind that we shouldn't be trying to reproduce a medical textbook, but writing a reference for lay people, and as such it's important that the overall tone is right-people might be reading up on this because their friends or relatives are moribund from liver failure-some poor sod may well find him/herself trying to placate distraught relatives who think that a wonder treatment is being withheld from their nearest and dearest.I suppose that's all I was trying to say.Felix-felix 17:01, 3 February 2006 (UTC)

So shall I change the title to 'Albumin Dialysis' with a link via liver dialysis when I get round to an edit? Is that the concensus?Felix-felix 11:24, 9 February 2006 (UTC)

So you propose moving this article to albumin dialysis? JFW | T@lk 13:17, 9 February 2006 (UTC)

>to my mind doesn't give the impression that there is an

>equivalent life-support therapy for liver failure to hemo

>or peritoneal dialysis for renal failure. I

I don't think equivalent survival is an appropriate measure. Any case, I'd give the lay public a bit more credit. Also, if I were to take your logic-- we should give pancreatic cancer and prostate cancer different names 'cause people might think pancreatic cancer is mostly harmless (like prostate cancer is-- mostly).

Why do you say that prostate cancer is mostly harmless, Nephron? Second commonest cause of male cancer death in the UK after Lung cancer. Also, the point is that they're both neoplasms-the same pathological process-haemo and peritoneal dialysis use the principle of diffusion over a semi-permeable membrane-'liver dialysis HAS to use albumin on the extra-corporeal circuit as a chelating agent, or it doesn't work. A better analogy was your 'diffusion and facilitated diffusion' one, as the terms are qualified-perhaps 'albumin facilitated dialysis'? The difference in effectiveness is not a good reason on it's own to change the name, it's simply an extra one-as I would have thought was obvious.Felix-felix 13:51, 17 February 2006 (UTC)

A disease with a low mortality and high prevalence kills many. When I wrote mostly harmless - I was thinking about the prevalence in autopsy, which can be approximated by the man's age (that is 80% of 80-year olds have prostate ca).[1] Prostate cancer in most cases isn't diagnosed... and we could look for it but it doesn't matter. The majority of 80-year olds have prostate ca... but they won't die from it-- that's what I was thinking of when I wrote mostly harmless. This stands in stark contrast to people that have pancreatic cancer. I was thinking mostly about the comparison and did not make that clear. In the grand scheme of things prostate cancer, as an entity, most certainly is not harmless-- and most especially if diagnosed. Nephron 23:18, 19 February 2006 (UTC)

I think we ought to consider how the terms liver dialysis and albumin dialysis are related to the terms renal dialysis and hemodialysis. I think albumin dialysis is a subset of liver dialysis-- as hemodialysis is a subset of renal dialysis. When considered in this way-- I think the term liver dialysis is appropriate for the given article-- unless we have two articles... one that is liver dialysis-- another that is albumin dialysis. Nephron 05:03, 10 February 2006 (UTC)

Yes, I propose changing the name to Albumin Dialysis, Nephron, the point here is that ALL the therapies here use albumin as a basis for the action of 'toxin removal'. There are no therapies that you've mentioned here which don't use albumin as a cleaning agent/chelating agent, thus i don't really see that 'liver dialysis' can be either a different category or an umbrella one. Also the term 'Liver dialysis' is one that's pushed fairly eagerly by the developing industries to market it, and I think that a more neutral and precise title is better for an encyclopedia. As i've said before, we should bear in mind that this is for a lay audience, and as such the tone should be appropriate for that. This therapy will never keep liver failure patients alive on it's own-and is dissapointing even as a briging device as it stands. A title of Albumin Dialysis with a redirect from Liver Dialysis is my vote.Felix-felix 13:34, 17 February 2006 (UTC)

[edit] Apologies

There is a type of 'liver dialysis' which doesn't use albumin-which is the HemoTherapies Unit™ which apparently uses a dialysate with a suspension of charcoal particles and cation exchangers (adsorbtion resins?).FDA approved on saftey only, and no benefit on the one trial it's undergone-but there you are. Perhaps 'facilitated dialysis'? I'll abide by the concensus.Felix-felix 14:13, 17 February 2006 (UTC)

No need to be apologic. One can't be expected to be right 100% of the time.

As for facilitated dialysis, personally, I think it is a reasonable description-- but it is poorly suited for Wikipedia.

I think your objection to the term liver dialysis is based on the assumption that the manufacturers want to live off the perception people have of kidney dialysis. I think the term was coined more 'cause it describes the process/objective. The fact that it doesn't work very well ought not distract from that too much. Success rates for different types of transplantation vary quite significantly (e.g. bowel transplant vs. kidney transplant) -- yet they we don't call one 'kidney transplant' the other something like bowel replacement therapy.

You seem irriated by the thought that people might think liver dialysis is a walk in the park. Personally, I think the term liver dialysis should stay. If you want to discuss the crappy survival (and yeah--I agree it is really crappy) --I think that belongs in the article (i.e. write a section 'Survival on liver dialysis and in it compare survival to that of patients with ESRD. The kidney dialysis articles, in that respect, are severely lacking... as you could say that many kidney patients expect that with (renal) dialysis they have a normal life expectancy and quality of life--- when the reality is that they have a poor quality of life and much reduced life expectancy.

The survival of ESRD patients is significantly poorer when compared to patients with other major illnesses such as prostate and colon cancer. [2]

Any case, I think facilitated dialysis isn't widely used... by anyone and we shouldn't be coining new terms. Encyclopedias don't aim to correct the bad terminology out there--their goal is to explain/summarize knowledge already out there. Nephron 00:04, 20 February 2006 (UTC)

[edit] Bioartificial liver devices

I split-out bioartificial liver device ('cause I think it deserves it own article) and created an article called artificial extracorporeal liver support to disambig the articles liver dialysis and bioartificial liver device. Nephron  T|C 06:58, 19 January 2007 (UTC)